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Teaching Autonomy

Autonomy in the OR

At Northwestern, we believe in advancing residents along a path of graduated autonomy with direct supervision from expert faculty. The goal is to produce competent, safe, and technically excellent graduates who can independently perform the breadth of core general surgery procedures, while having the wisdom to know when to call for help. Rotation schedules and resident teams have been structured to allow for substantial exposure to the OR starting intern year. Residents participate in increasingly complex operations as they progress through the program, allowing for level-appropriate autonomy.


We objectively measure each residents’ progression to operative autonomy using a smart-phone app called SIMPL, which was developed at Northwestern, and is currently used at residency programs throughout the country. SIMPL allows for faculty to grade resident operative autonomy and performance immediately after every operation and dictate verbal feedback. Additionally, SIMPL links to the ACGME resident case-log system, which makes logging cases faster. Data derived from SIMPL allows our program leadership to ensure that residents are all progressing appropriately and target areas for additional practice and focus for individual residents.

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